Royal Garden Board & Care III

Type of visit: Required - 1 Year

At 1:35 pm Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by the administrator and disclosed purpose of visit. LPA conducted a tour of the physical plant at approximately 1:38 pm to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common areas were observed for the ability to safely serve the needs residents. These included the guest lounge,living room, kitchen and dining room. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately with adequate seating for residents. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the six (6) residents currently residing there. Two (2) days of perishable food and seven (7) days non-perishable food observed. The freezer is stocked with meats and frozen vegetables. The medications and first aid are stored in locked upper kitchen cabinets. Sharps stored and locked in kitchen drawer beneath the medication cabinet. Medications and sharps observed to be inaccessible to residents. Toxins stored under kitchen sink cabinet and observed to be locked and inaccessible to residents. There are two (2) fire extinguishers: one (1) in kitchen wall near refrigerator, one (1) in hallway next to bedroom # 6 attached to wall. Laundry room in guest bathroom near dining room. The appliances observed to be functional and in good repair. (Cont from 809) The facility has a total of seven (7) bedrooms; with one (1) designated for staff; and seven (7) bathrooms: six (6) private bathrooms for residents. The resident bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens in resident rooms. Each bathroom has posted “wash your hands” signs and the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the six (6) bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 112.9, 112.9, 110.0, 113.5, 108.3, and 110.6-degrees Fahrenheit. There is a courtyard patio area in the front of facility. Patio furniture observed to be in good repair. Backyard has the following: Large Gazebo with table with chairs and three (3) separate patio areas. Patio furniture observed to be in good repair. Storage room in backyard for PPE/water/emergency supplies. No garage at facility Smoke detectors/carbon monoxide detector were tested and operable at time of visit. Exit door alarms operable at time of visit. Facility grounds were free of hazards. At approximately 02:35 pm, LPA reviewed files for the six (6) residing residents. Resident files review includes but not limited to: admissions agreement, physicians’ assessment, appraisals, consent, and personal right forms. Staff files reviewed for four (4) staff. Staff files had medication trainings, dementia training's, certificate including current First aid/AED/CPR certificates. Facility has dementia and bedridden plan. There were no immediate health and safety hazard observed during the day of inspection. Exit Interview Conducted / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, May 27, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava arrived conducted a required Annual Inspection infection control vist at the facility. Upon arrival of the facility, LPA observed a large courtyard with patio furnishings for residents to sit outside. LPA met with the administrator, Alexander Kigel and caregiver Gerardo Centeno. LPA observed two (2) residents in the living room watching television, and the other three (3) residents in their rooms. Personnel summary was verified for criminal record/association; all staff were cleared. LPA observed one (1) staff on duty, and the administrator. Licensee Sophia Labendze was notified of the visit via telephone. The current census is five (5). Facility license and sketch, rights of resident council, grievance/complaint procedures, emergency disaster plan, resident bill of rights, personal rights, and neighborhood complaint procedures were visibly posted. A physical plant tour of the facility inside and outside was conducted with caregiver Gerardo at around 11:15am. The following common areas: living, dining, kitchen, resident bedrooms, and bathrooms, was inspected to ensure the facility was in compliance with Title 22 Regulations: Kitchen: Food service area had Licensing requirement of (7) day nonperishable, and (2) day perishable. Food was properly stored in a healthy manner. Frozen foods were properly wrapped and stored appropriately. There was a pantry, stocked with non-perishable. Food storage and preparation areas were clean and inaccessible to pests and toxins. Appliances were functional and clean. Chemicals, household supplies, and knives, and medication, was locked and stored in kitchen cabinets. Appliances had functional fixtures, and in good repair. Living/dining/family/: All indoor passageways were free from obstruction; inside temperature was comfortable and measured at 77 degrees. All areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (6) private bedrooms; with (1) room for staff. All bedrooms were properly properly furnished with appropriate bedding and linens. Rooms observed to have bedspread, sheets, pillowcase, mattress pad, and blankets, which all were in good repair. There were sufficient linens observed and available. Bathrooms: There are (7) bathrooms; all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured in several resident’s bathrooms between 105 and 115 degrees Fahrenheit. Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. There is a covered patio with appropriate seating for residents. Smoke alarms and carbon monoxide detectors are battery operated and were functional. Fire extinguishers in the hallway and kitchen were fully charged. The charge date was 07/26/21. First aid kit furnished fully equipped. All exit doors have alarms; all were operating correctly. Pursuant to title 22, division 6, chapter 8, there was no immediate health and safety hazard observed at this time. The administrator was advised and a copy of this report given.the state’s words, verbatim · CDSS document, Apr 29, 2022

Allegation investigated: Staff failed to provide adequate supervision, resulting in resident 1(R1) wandering away from the facility.

Licensing Program Analyst (LPA) Calvin Tsui and Licensing Program Manager (LPM) Eva Miller conducted a subsequent complaint visit at the facility and met with Gerardo Centeno and Rada Sigal The complainant alleged that Resident #1 (R-1) left the facility on or about 9/3/21 without the knowledge of the direct care staff on duty. R-1 was delivered to Kaiser Hospital Emergency Room (ER) at approximately 7:00am by a member of the public who happened upon R-1 in the community. Hospital Personnel contacted R-1's daughter who subsequently contacted the Facility Administrator. Staff on duty (S-1) last observed R-1 in the faciltiy at approximately 4:00am on 9/3/21 via a video monitor. S-1 observed that R-1 was not in bed at approximately 4:30am via a video monitor but did enter the room to ascertain R-1's status. S-1 did not determine that R-1 was missing until approximately 6:00am. S-1 reported the missing resident to the Administrator and the two conducted an unsuccessful search of the immediate neighborhood, after which they reported the missing resident to the Los Angeles Police Department (LAPD). Substantiated The Administrator was advised that R-1 had been found at the Kaiser Hospital ER by R-1's daughter via telephone. R-1 was provided with an examination at the ER and subsequently returned to the facility on the same day. LPA Tsui and LPA Yelena Avetisyan conducted an initial investigative visit at the facility on 9/9/21. A tour of the physical plant was conducted as well as interviews with Staff and the Administrator and a review of facility records for R-1. During the tour of the physical plant the LPA's observed that two of the auditory alarms were not operational. An interview with the daughter of R-1 was conducted via telephone by LPA Tsui and LPM Miller on 9/21/21 at 8:30am. Based on the content of the interviews conducted on 9/9/21 from 2:00pm and 3:10pm and the interview with the daughter of R-1 on 9/21/21 as well as a tour of the physical plant on 9/9/21, LPA Tsui was able to substantiate the allegation that due to a lack of care and supervision by Direct Care Staff R-1 was able to leave the facility without their knowledge placing R-1 at risk. Citations issued, appeal rights provided and exit interview conducted.the state’s words, verbatim · CDSS document, Sep 21, 2021 · control 31-AS-20210903113520

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(j) · Plan of correction due date: Sep 21, 2021

Care of Persons with Dementia. The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement was not met as evidenced by: Based on the observations of LPA's the alarm on the exit door was inoperable in Rm#6. Staff stated alarm had been in-op for a minimum of 1 week so staff disabled the alarm resulting in an immediate risk to the health & safety of residents in care.the state’s words, verbatim · CDSS document, Sep 21, 2021

Plan of correction: Administrator agrees to ensure all auditory alarms are functional and activated. An additional auditory alarm will be installed to the outside of the exterior door to the room for R-1. At the time of this visit all bedroom exterior doors have functional auditory alarms installed on the inside are functional

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 21, 2021

Personnel Requirements - General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on observations by LPA's and statements by Staff, R-1 was able to leave the facility without the knowledge of staff on duty indicating insufficient staffing resulting in an immediate risk to the health & safety of residents in care.the state’s words, verbatim · CDSS document, Sep 21, 2021

Plan of correction: Administrator agrees to ensure all auditory alarms are functional and activated. An additional auditory alarm will be installed to the outside of the exterior door to the room for R-1. At the time of this visit all bedroom exterior doors have functional auditory alarms installed on the inside are functional. There will be at a minimum one awake staff at night.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Calvin Tsui and Licensing Program Manager (LPM) Eva Miller conducted a Case Management visit in reference to deficiencies observed during the investigation of a complaint (Control #31-AS-20210903113520). On 9/9/21, LPA Calvin Tsui & LPA Yelena Avetisyan observed that the facility did not have a documented Absentee Notification Plan as required. On 9/9/21, the LPA's observed that the exterior door to R-1's bedroom (#5) was blockaded with the use of furniture placed outside the door to prevent R-1 from exiting. This deficiency violates the Fire Clearance by blocking an exit and is a Zero Tolerance Deficiency. Citations issued, Civil Penalties Assessed, Appeal Rights provided and an exit interview conducted.the state’s words, verbatim · CDSS document, Sep 21, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(l)(2) · Plan of correction due date: Sep 21, 2021

Care of Persons with Dementia. The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (2)The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. This requirement was not met as evidenced by observations by LPA's that the exterior door to the bedroom of R-1 was blockaded without fire clearance approval to prevent exit resulting in an immediate threat to the health & safety of residents in care. Zerio Tollerance.the state’s words, verbatim · CDSS document, Sep 21, 2021

Plan of correction: The obstructions to the Door for R-1's room had been removed. Deficiency Cleared.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.317 · Plan of correction due date: Sep 28, 2021

Absentee notification plan for missing residents. Every RCFE shall,develop and comply with an absentee notification plan as part of the written record of the care the resident will receive in the facility, as described in Section 1569.80. This requirement was not met as evidenced by: Based on Observations of LPA's during records review there was no absentee notification plan in place for Resident #1 resulting in a potential risk to the health and safeth of resident(s) in care.the state’s words, verbatim · CDSS document, Sep 21, 2021

Plan of correction: Administrator agrees to generate and submit an absentee notification plan for each resident in care and specific to each individual resident.